RESUMEN
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Asunto(s)
Humanos , Masculino , Aneurisma Falso/sangre , Aneurisma Falso/patología , Hemorragia Gastrointestinal/sangre , Hemorragia Gastrointestinal/genética , Colecistitis/patología , Hemobilia/sangre , Espectroscopía de Resonancia Magnética , Aneurisma Falso/genética , Aneurisma Falso/metabolismo , Hemorragia Gastrointestinal/metabolismo , Hemorragia Gastrointestinal/patología , Colecistitis/metabolismo , Hemobilia/patología , Espectroscopía de Resonancia Magnética/instrumentaciónAsunto(s)
Anastomosis Quirúrgica/métodos , Colelitiasis/cirugía , Hemobilia/cirugía , Arteria Hepática/cirugía , Conducto Hepático Común/cirugía , Adulto , Colecistectomía Laparoscópica , Colelitiasis/patología , Femenino , Hemobilia/patología , Arteria Hepática/patología , Conducto Hepático Común/patología , Humanos , ReoperaciónAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Hemobilia/complicaciones , Hemobilia/diagnóstico , Aneurisma Falso/complicaciones , Aneurisma Falso/diagnóstico , Arteria Hepática/patología , Arteria Hepática , Angiografía/métodos , Colangitis/diagnóstico , Colecistectomía/métodos , Hemobilia , Angiografía , Colangitis/complicaciones , Hemobilia/patología , Aneurisma Falso , Endoscopía , Endoscopía del Sistema Digestivo , Succión/instrumentaciónAsunto(s)
Hemobilia/patología , Trasplante de Hígado/patología , Pancreatitis/patología , Complicaciones Posoperatorias/patología , Conductos Biliares/patología , Biopsia , Pancreatocolangiografía por Resonancia Magnética , Hemobilia/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Conductos Pancreáticos/patología , Pancreatitis/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Polyposis of the gallbladder is rare during childhood. This condition can be associated with three other conditions: metachromatic leukodystrophy, Peutz-Jeghers' syndrome, and pancreaticobiliary maljunction. We report the case of a child with hemobilia in metachromatic leukodystrophy, which rendered cholecystectomy necessary. Macroscopically, the gallbladder measured 4.6 cm in length and showed an opaque serous surface and focal brown petechiae. Moreover, a yellow polypoid lesion of 2 cm in diameter and a diffuse thickening of the fundus wall were observed. Many reports describe the importance of the association of gallbladder papillomatosis with metachromatic leukodystrophy, but only three cases presented with massive intestinal bleeding, such as our young patient had. It is thus imperative that this life-threatening condition should be well known.
Asunto(s)
Neoplasias de la Vesícula Biliar/complicaciones , Hemobilia/complicaciones , Leucodistrofia Metacromática/complicaciones , Leucodistrofia Metacromática/patología , Papiloma/complicaciones , Preescolar , Neoplasias de la Vesícula Biliar/patología , Hemobilia/patología , Humanos , Masculino , Papiloma/patologíaAsunto(s)
Tumor Carcinoide/veterinaria , Enfermedades de los Perros/patología , Neoplasias de la Vesícula Biliar/veterinaria , Hemobilia/veterinaria , Animales , Tumor Carcinoide/complicaciones , Colestasis Extrahepática/veterinaria , Perros , Femenino , Neoplasias de la Vesícula Biliar/complicaciones , Hemobilia/patología , Hemorragia/veterinaria , Masculino , Trombosis/veterinariaRESUMEN
Pancreatic arteriovenous malformations (AVM) are extremely rare diseases frequently complicated by gastrointestinal hemorrhage. While surgical resection of affected lesion is preferred for the treatment of pancreatic AVM, angiographic intervention can be used as an alternative treatment, especially in surgically high-risk patients. We experienced a patient with pancreatic AVM manifested by hemobilia and biliary sepsis. Superior mesenteric and common hepatic arteriography showed pancreaticoduodenal AVM composed of nidus supplied by numerous fine feeding arteries and of draining veins encircling the common bile duct (CBD). Hemobilia was controlled by transportal coil embolization of draining veins of AVM around the CBD. Herein, we report this case with the review of literatures.
Asunto(s)
Malformaciones Arteriovenosas/terapia , Embolización Terapéutica , Hemobilia/terapia , Páncreas/irrigación sanguínea , Malformaciones Arteriovenosas/patología , Duodenoscopía , Hemobilia/etiología , Hemobilia/patología , Humanos , Masculino , Persona de Mediana Edad , Pancreaticoduodenectomía , Tomografía Computarizada por Rayos XRESUMEN
Liver biopsy is generally considered a safe and highly useful procedure. It is frequently performed in an outpatient setting for diagnosis and follow-up in numerous liver disorders. Since its introduction at the end of the 19th century, broad experience, new imaging techniques and special needles have significantly reduced the rate of complications associated with liver biopsy. Known complications of percutaneous biopsy of the liver include hemoperitoneum, subcapsular hematoma, hypotension, pneumothorax and sepsis. Other intra-abdominal complications are less common. Hemobilia due to arterio-biliary duct fistula has been described, which has only rarely been clinically expressed as cholecystitis or pancreatitis. We report a case of a fifteen year-old boy who developed severe acute cholecystitis twelve days after a percutaneous liver biopsy performed in an outpatient setting. The etiology was clearly demonstrated to be hemobilia-associated, and the clinical course required the performance of a laparoscopic cholecystectomy. The post operative course was uneventful and the patient was discharged home. Percutaneous liver biopsy is a safe and commonly performed procedure. However, severe complications can occasionally occur. Both medical and surgical options should be evaluated while dealing with these rare incidents.
Asunto(s)
Biopsia con Aguja/efectos adversos , Colecistitis/etiología , Hemobilia/etiología , Enfermedad Aguda , Adolescente , Colecistectomía Laparoscópica , Colecistitis/patología , Colecistitis/cirugía , Hemobilia/complicaciones , Hemobilia/patología , Humanos , MasculinoRESUMEN
The case of a patient with Crohn's disease and who presented 4 days after a percutaneous liver biopsy with haematochezia suggestive of an exacerbation of his inflammatory bowel disease is described. Subsequent abdominal ultrasonography revealed free fluid in the peritoneal cavity and around the gallbladder. Haemobilia was suspected. Selective hepatic arteriography demonstrated a fistula between the hepatic artery and the portal venous system, with the presence of a hepatic artery pseudoaneurysm. Bleeding was stopped by arterial embolisation using titanium microcoils. Haemobilia is a very rare complication of percutaneous liver biopsy, but it should not be overlooked as a potential late-onset cause of rectal bleeding following this procedure. Selective hepatic arterial embolisation is an effective and safe treatment for this serious complication.
Asunto(s)
Enfermedad de Crohn/complicaciones , Hemorragia Gastrointestinal/etiología , Hemobilia/complicaciones , Adulto , Fístula Arteriovenosa/etiología , Biopsia/efectos adversos , Enfermedad de Crohn/patología , Hemorragia Gastrointestinal/patología , Hemobilia/patología , Arteria Hepática/anomalías , Humanos , Hígado/patología , Masculino , Vena Porta/anomalíasAsunto(s)
Abdomen Agudo/etiología , Enfermedades de la Vesícula Biliar/diagnóstico por imagen , Hemobilia/diagnóstico por imagen , Abdomen Agudo/diagnóstico por imagen , Adulto , Vesícula Biliar/diagnóstico por imagen , Vesícula Biliar/patología , Enfermedades de la Vesícula Biliar/patología , Hemobilia/patología , Humanos , Trasplante de Riñón , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/patología , UltrasonografíaRESUMEN
We present a 66-year-old man with unique heterotopic gastric mucosa in the intrahepatic bile duct causing hemobilia. Endoscopic retrograde cholangiography showed irregular stenosis of the left intrahepatic bile duct, and a provisional diagnosis of cholangiocarcinoma was made. Therefore, partial hepatic lobectomy and cholecystectomy were performed. Histological examination of the liver showed the presence of ectopic gastric mucosa in the intrahepatic bile duct containing mucous glands with parietal and chief cells and bile. Heterotopic gastric mucosa in the intrahepatic bile duct is a rare cause of hemobilia.
Asunto(s)
Enfermedades de los Conductos Biliares/diagnóstico , Conductos Biliares Intrahepáticos , Coristoma/diagnóstico , Mucosa Gástrica , Hemobilia/etiología , Anciano , Enfermedades de los Conductos Biliares/patología , Enfermedades de los Conductos Biliares/cirugía , Conductos Biliares Intrahepáticos/patología , Conductos Biliares Intrahepáticos/cirugía , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomía , Coristoma/patología , Coristoma/cirugía , Diagnóstico Diferencial , Hemobilia/patología , Hemobilia/cirugía , Hepatectomía , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
Arteriovenous malformation of the pancreas is a very rare entity. We describe a case involving the head of the pancreas associated with progressive hemobilia bleeding from the lower part of the common bile duct. The patient was a 50-year-old man with acute epigastralgia. Endoscopic retrograde cholangiopancreatography revealed hemobilia and cystic dilation of the common bile duct. Angiography demonstrated increased blood volume in the head of the pancreas and early filling of the superior mesenteric and portal veins. Abdominal pain and progressive anemia caused by hemobilia required surgical treatment. Histologic examination of the resected specimen revealed marked proliferation of the blood vessels in the pericholedochal area and the exact point of bleeding from the pancreaticobiliary arteriovenous malformation.
Asunto(s)
Malformaciones Arteriovenosas/diagnóstico por imagen , Quiste del Colédoco/diagnóstico por imagen , Conducto Colédoco/irrigación sanguínea , Hemobilia/diagnóstico por imagen , Páncreas/irrigación sanguínea , Angiografía , Arterias/patología , Malformaciones Arteriovenosas/patología , Malformaciones Arteriovenosas/cirugía , Colangiografía , Colangiopancreatografia Retrógrada Endoscópica , Quiste del Colédoco/patología , Quiste del Colédoco/cirugía , Hemobilia/patología , Hemobilia/cirugía , Humanos , Masculino , Persona de Mediana Edad , Pancreaticoduodenectomía , Poliarteritis Nudosa/diagnóstico por imagen , Poliarteritis Nudosa/patología , Poliarteritis Nudosa/cirugía , Venas/patologíaRESUMEN
Massive hemobilia is a well recognized clinical entity, particularly when it presents with jaundice, GI bleeding, and biliary pain. However, occult hemobilia is more difficult to diagnose and has seldom been reported because of its clinically silent nature. In fact, this is usually overlooked until complications arise. Hemocholecyst or clot within the gallbladder may rarely occur in this setting, leading to cystic duct obstruction and cholecystitis. Most previous reports describe cholecystitis resulting from hemocholecyst after iatrogenic trauma. We describe two cases in which hemocholecyst occurred from underlying malignancies, both resulting in cholecystitis (acute or chronic).
Asunto(s)
Carcinoma Hepatocelular/complicaciones , Colecistitis/etiología , Neoplasias del Conducto Colédoco/complicaciones , Hemobilia/etiología , Neoplasias Hepáticas/complicaciones , Neoplasias Pancreáticas/complicaciones , Trombosis/etiología , Anciano , Anciano de 80 o más Años , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/patología , Colecistitis/diagnóstico , Colecistitis/patología , Neoplasias del Conducto Colédoco/diagnóstico , Neoplasias del Conducto Colédoco/patología , Diagnóstico Diferencial , Femenino , Vesícula Biliar/patología , Hemobilia/diagnóstico , Hemobilia/patología , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patología , Masculino , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patología , Trombosis/diagnóstico , Trombosis/patologíaRESUMEN
We report herein the extremely unusual case of a 39-year-old woman in whom a giant cavernous hemangioma caused hemobilia. Cavernous hemangioma is the most common benign neoplasm of the liver and rarely causes any clinical symptoms or signs, while hemobilia usually occurs secondary to accidental operative or iatrogenic trauma, vascular disease, inflammatory disorders, gallstones, or tumors of the liver. Although invasive or malignant hepatic tumors often result in a communication between the biliary tract and the blood vessels, only one case of hemobilia caused by a benign cavernous hemangioma has ever been reported, but with no details about the patient. Our patient presented to a local hospital with severe melena as the initial main symptom, where ligation of the right hepatic artery was performed. This failed to relieve her symptoms, and she was subsequently referred to our department where a right hepatectomy was performed. Histopathological examination revealed no malignancy combined with the tumor; however, the hemangioma was exposed to the bile duct in segment VIII, which was presumably the cause of the hemobilia. This patient remains in good health almost 6 years after her operation. To the best of our knowledge this is the first case report of hemobilia caused by a cavernous hemangioma, and is accompanied by a detailed analysis.
Asunto(s)
Hemangioma Cavernoso/complicaciones , Hemobilia/etiología , Neoplasias Hepáticas/complicaciones , Adulto , Diagnóstico Diferencial , Diagnóstico por Imagen , Femenino , Hemangioma Cavernoso/patología , Hemangioma Cavernoso/cirugía , Hemobilia/patología , Hemobilia/cirugía , Hepatectomía , Humanos , Hígado/patología , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugíaRESUMEN
PURPOSE: To evaluate the effect of bile on smooth muscle cell (SMC) proliferation in vitro and in vivo in a porcine transjugular intrahepatic portosystemic shunt (TIPS) model. MATERIALS AND METHODS: In vitro, SMCs explanted from porcine thoracic aorta were cultured with standard techniques. After initial pilot studies, they were subcultured in one of three groups: 1% porcine serum plus 1% bile, 10% porcine serum plus 1% bile, and 10% porcine serum. Cells were harvested at 3, 10, or 14 days, and DNA, protein, and disintegrations per minute (an indicator of proliferation) were measured. In vivo, TIPS creation was successful in 45 swine. All pigs were euthanized at 10-16 days. The proliferative response within the stent was histologically quantified and correlated for evidence of bile leak. RESULTS: In pilot studies, 2.5%-10.0% bile solutions caused 100% SMC mortality by 3 days. In the presence of 1% bile (with or without porcine serum), both DNA and protein production decreased significantly compared with that in porcine serum alone (P < .05). In vivo, 13 of 45 specimens (29%) showed bile leak at gross or microscopic examination. SMC proliferation was less overall in animals with versus those without bile leak (difference not significant). CONCLUSION: These data suggest that the proliferative response in a TIPS is not primarily due to bile leak. Bile leak may promote thrombosis, but it appears to inhibit myointimal proliferation.
Asunto(s)
División Celular/efectos de los fármacos , Hemobilia/patología , Músculo Liso Vascular/patología , Derivación Portosistémica Intrahepática Transyugular , Stents , Animales , Células Cultivadas , Replicación del ADN/efectos de los fármacos , Diseño de Equipo , Análisis de Falla de Equipo , Derivación Portosistémica Intrahepática Transyugular/instrumentación , PorcinosRESUMEN
A 52-year old woman was admitted to the hospital because of upper abdominal pain and hematemesis. Laboratory parameters showed marked cholestasis. Endoscopic retrograde cholangiopancreatography (ERCP) lead to the diagnosis of hemobilia. CT-scan and angiography revealed an aneurysm of the cystic artery as the cause of hemobilia. Cholecystectomy was performed because of concomitant cholecystitis. Anatomical examination confirmed clinical diagnosis.
Asunto(s)
Aneurisma/diagnóstico , Conducto Cístico/irrigación sanguínea , Hemobilia/etiología , Aneurisma/patología , Aneurisma/cirugía , Angiografía , Arterias/patología , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomía , Colecistitis/diagnóstico , Colecistitis/patología , Colecistitis/cirugía , Enfermedad Crónica , Diagnóstico Diferencial , Femenino , Hemobilia/patología , Hemobilia/cirugía , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
A rare case of spurious aneurysm of an aberrant right hepatic artery is reported. Endoscopic retrograde cholangio-pancreaticography, computed tomography and selective angiography of the coeliac trunc are diagnostic. Resection of the aneurysm and interposition of saphenous vein is the preferred procedure. In selected cases ligation of the common hepatic artery is possible. Intrahepatic aneurysms are preferably treated interventionally.
Asunto(s)
Aneurisma Infectado/cirugía , Aneurisma Roto/cirugía , Hemobilia/cirugía , Arteria Hepática/anomalías , Anciano , Ampolla Hepatopancreática/patología , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/patología , Aneurisma Roto/diagnóstico , Aneurisma Roto/patología , Diagnóstico por Imagen , Femenino , Hemobilia/etiología , Hemobilia/patología , Arteria Hepática/patología , Arteria Hepática/cirugía , Humanos , Venas/trasplanteRESUMEN
Haemobilia is defined as bleeding into the hepatobiliary system caused by a pathologic connection between blood vessels and biliary ducts. A rare cause of haemobilia is gallstone disease, with only 52 reported cases in the literature. The haemobilia is characterised by the classical triad: jaundice, colicky pain in the right upper quadrant and signs of gastrointestinal bleeding. Diagnosis can be made with endoscopic procedures and with angiography of the coeliac trunk, which has the highest sensitivity in localisation of bleeding source. The therapy of choice is cholecystectomy. We report the case of a patient with massive gastrointestinal haemorrhage caused by a solitary gallstone and present the diagnostic and therapeutic management of this disease, which is accompanied by a high mortality.
Asunto(s)
Colelitiasis/complicaciones , Hemorragia Gastrointestinal/etiología , Hemobilia/etiología , Anciano , Anciano de 80 o más Años , Angiografía , Colelitiasis/patología , Colelitiasis/cirugía , Diagnóstico Diferencial , Vesícula Biliar/irrigación sanguínea , Vesícula Biliar/patología , Hemorragia Gastrointestinal/patología , Hemorragia Gastrointestinal/cirugía , Hemobilia/patología , Hemobilia/cirugía , Humanos , MasculinoRESUMEN
To define the clinical significance of delayed postsphincterotomy hemorrhage, we reviewed 476 consecutive ERCP procedures performed over a three-year period. Of 250 patients who underwent endoscopic sphincterotomy (ES), five (2%) developed postprocedure hemorrhage, two of whom had immediate, self-limited bleeding that resolved after endoscopic injection of epinephrine and did not require transfusion. The other three had delayed hemorrhage characterized by: onset 20-48 hr after the procedure, melena without hematemesis as the index clinical manifestation of bleeding, and atraumatic balloon extraction of common duct stones. Transfusion of 2-6 units of packed erythrocytes was necessary in each and one patient required surgical hemostasis. Delayed hemorrhage following ERS is an important, frequently severe complication to remember when contemplating performing ERS as an outpatient procedure.